Polenta and greens casserole

The last few months have been some of the most challenging of residency.  I felt stretched to the limit of emotional and mental energy.  4am and I became great friends. 

The greatest challenge is fitting “it all” in.  There are only 24 hours in a day.  With work between 12 and 16 hours a day plus commuting to work, bathing, and dressing, what does that leave? At least I’m lucky enough to be able to come home every night as we have a night float system. 

What is “it all” then?  There’s no such thing.  For me, making dinner, exercising 3 to 4 times a week, sleeping, spending time with my husband and occasionally meeting a friend is enough.  Long gone are the days of piano lessons, reading Madame Bovary, and watching Law and Order marathons.

But sometimes I need those piano lessons and Law and Order marathons to feel like me.  And sometimes I need “me” to be there when my patients are sick and asking hard questions.  So thank God for some moments of peace and quiet for the past couple of weeks.  Thank God for sleep and books, mountains and fresh air.  Bless the hour I had to sit in front of the stove on a Sunday afternoon and lazily stir polenta. 

I shouldn’t complain.  I should be grateful to have a job at all, especially one that I like that’s fulfilling.  It could always be worse, much much worse.  But I want my life to be great.  So, I’m just going to keep trying to find those moments just for me to make me me.  Keep stirring my polenta.

This polenta casserole could be lasagna’s green, vegetarian, gluten free cousin.  It is a great main course but also a wonderful side dish.  It is quite rich but also very healthy, thanks to a properly made polenta that tastes rich with just salt and water.  It is topped with a layer of green veggies and a small layer of cheese and butter to help it brown.  The beauty of this dish though is that it could be an afternoon affair or very quick to prepare.  It could be made with pre-cooked polenta in one of those plastic tubes and topped with frozen spinach which would still be delicious. 

Polenta and greens casserole

4 cups cooked polenta***

2 cloves garlic

4 eggs

½ cup skim milk

1 can artichokes in brine

2 bunches fresh greens (I used yellow beet greens and brocollini) but the options are endless, kale, chard and spinach would all be wonderful

½ lb brussel sprouts quartered

6 oz fresh mozzarella

¼ cup fresh parmesan grated

1 tbs unsalted butter

salt and pepper

chili flakes

Make the polenta or unwrap it.  Pre-heat the oven to 375.  Butter an 8x8 casserole.  Pat down the polenta into the bottom of the casserole in an even layer.  Bring a large pot of salted water to a boil.  Blanch the greens in the boiling water for 5 minutes.  Remove the greens and strain but keep the water boiling.  Chop the greens and wring out all of the water by squeezing them in your hands or through a strainer.  Blanch the brussel sprouts for 5 minutes in the same water as the greens.  Do not press but drain well as you want the vegetable layer to have as little water as possible.  Drain the artichokes, chop and wring as much liquid as possible from them.  In a medium bowl whisk the eggs and milk with salt and pepper until the eggs are foamy and a paler color.  Add the vegetables, chili flakes and garlic to the egg mixture and stir to combine.  Layer the egg mixture on top of the polenta.   Thinly slice the mozzarella.  Evenly distribute the cheese on top of the casserole.  Add the grated cheese.  Cut the butter into very small pieces and place on top of the casserole.  Bake for 45 minutes at 375.  Increase the temp of the oven to 450 and bake for another 10 minutes until golden and bubbly. 

****To make the polenta, I stole the recipe/idea from Marcela Hazan.  You need 7 cups of heavily salted water boiling over medium high heat in a large pot.  With 1 2/3 cups of Italian polenta add the corn meal grain by grain through your hand over boiling water, constantly stirring to avoid lumps.  Continue to stir.  Once the mixture starts to be violent and sputter, reduce the heat to medium-low or until there are only a few bubbles emerging from the polenta.  Continue to stir constantly with a wooden spoon.  After about 45 minutes, the mixture will be thick and will completely come off the sides of the pot. 

Pickling it up--Italian style grilled spring veggie pickles

As my resident life advances and becomes more surgical, having clamped through my first few hysterectomies, tied and cut dozens of tubes of postpartum women, and delivered hundreds of babies abdominally through C-sections, I have had my share of complications.  My wise attending told me “if you haven’t had a complication from surgery, you haven’t done enough surgery.”

The inability to always prevent complications unsettles me.  An adverse outcome during a case provokes a feeling of desperation.  Sometimes I just feel like a stupid jerk that doesn’t want to operate anymore.  But I have to get over myself, because I’m going to be doing surgery for the rest of my life, and no matter how much I study and practice, things aren’t always going to go right. I am lucky to have great teachers who have coached me through fixing mistakes and counseling patients postoperatively. 

Thank god I have the kitchen.  Complications arise all the time, under-whipped egg whites, a cake that falls apart the second you invert it, awful tasting crab sauce, and overcooked T bones.  The beauty of the kitchen is the cauliflower won’t bleed, the chicken doesn’t need its ureters anymore (does a chicken even have ureters?), and best of all, there’s always Chipotle.

When I find myself in a funk at work, stressed or depressed, nothing distracts me like the kitchen, my improvised operating room.  Just like surgery, I gather my supplies, wash my hands, gown in an apron and begin.  The knife courses through pork fat and onions, on my feet for hours.   

The comparison between chefs and surgeons has been made more than once.  Both jobs heat up quickly, promote distended bladders and last long hours.   The stakes separate the two.  Kitchen failures are frustrating, sometimes depressing, but rarely scary or life changing.  I’m just fine with that. 

I’ll keep my day job and my hobbies separate, enjoying pickles in edible instead of existential forms.  These Italian style pickles with grilled spring vegetables taste salty, sour, oily and herby.  They make a great snack.  They are beautiful on their own or served over toast with ricotta for a wonderful bruschetta.  They would also taste great in a pasta salad, over grilled fish or a plethora of other foods.  They take a little effort, but they last for weeks.  I use a grill pan to grill the asparagus and eggplant, however roasting them in the oven or over an open grill would produce equally tasty results.

The veggies I use in the recipe below are just what I had in my fridge.  Surely other vegetables such as fennel, carrots, or zucchini would also be delicious.   The pickles do not taste sweet at all, the sugar merely softens the blow of the vinegar and salt, as does the water. 

Pickled Grilled Spring Veggies Italian Style

Half an eggplant

10 spears asparagus

1 red onion

½ head of cauliflower

2 ribs celery

4 birds eye chiles or other peppers

2 cloves garlic smashed

10 black peppercorns

½ tsp fennel seeds

½ tsp dried oregano

¼ cup chopped fresh parsley

¼ cup chopped fresh basil

1 ½ cup white vinegar

½ cup red wine vinegar

1 cup water

¼ cup plus 2 tbsp kosher salt

¼ cup sugar

½ cup canola oil, ¼ cup olive oil

olive oil and salt for grilling vegetables

To grill the eggplant, asparagus and onion:  Slice the eggplant into thin slices.  Cut off the woody end of the asparagus.  Cut the onion in half.  Salt and oil the veggies.  Over medium high heat on a grill pan, cook the vegetables in batches until they have grill marks and begin to soften, however they do not have to be completely cooked.  Cut the eggplant rounds in half, cut the asparagus into 1 inch pieces and slice the onions in strips.  Set aside.

Cut the cauliflower into small pieces and chop the celery.  Slice the chiles, keeping the seeds.  Over medium high heat in a medium pot, add the garlic, chiles, peppercorns, fennel and oregano until fragrant but not burnt, about 20 seconds.  Add the vinegars, water, sugar and salt and bring to a boil.  Add the basil, parsley, celery and cauliflower and cook for another 5 minutes. 

Pour the hot liquid in a large jar over the grilled vegetables.  Float the oil on top, if the oil does not cover the vegetables, add more.  Allow to cool on the countertop and then refrigerate overnight. 

Playing vegan with miso glazed acorn squash and soba noodles

In December after a week of steak eating, cookie baking and face stuffing, unfortunately much prior to Christmas, I decided to become a vegan.  Now I only could do it for a week, as my love for dairy, eggs and meat should be obvious.  But, I can assuredly say that I felt much better.  I had a lot more energy and was less hungry.

This blog is definitely in need of more vegetables.  I love eating vegetarian fare, but somehow steamed broccoli with lemon juice just never seems sexy enough.  Of course my husband never even touched this dish, but that’s ok because sometimes I need things for myself.

White miso paste has a very rich, salty and sweet taste to it. I cut the squash in half and then cut very thin slices with a sharp knife.  Then I painted the glaze of miso, maple, soy and sesame on and roasted the squash in a hot oven until it was bubbling. 

To make this a complete meal, I made a miso sauce to toss buckwheat soba noodles.  This is delicious hot or cold.   Now I know the pictures aren't pretty, but this is good. Playing vegan is fun sometimes!

Maple miso roasted acorn squash with soba noodles

For the squash

½ acorn squash

2 tbsp white miso paste

1 tbsp maple syrup

1 tbsp olive oil

2 tbsp soy sauce

drizzle sesame oil

For the noodles

2 tbsp miso paste

¼ cup hot water

2 tbsp grated ginger

1/2 garlic clove, grated

2 scallions finely chopped

drizzle sesame oil

1 package soba noodles

Preheat the oven to 400.  Cut the squash in half, then cut thin strips of squash, cutting those in half as well.  Mix the glaze and paint on with a pastry brush.  Bake the squash until it is golden brown and bubbling about 20 minutes. 

For the noodles.  Make the noodles according to the directions.  Combine the rest of the ingredients and toss with the hot noodles and squash.  

Acclimating—With Cold Zucchini Basil Soup

Greetings from Texas!  After a round-a-bout road trip from Cleveland to Dallas via Chicago, Wisconsin and Minneapolis, a golf cart tour of Reedsburg, Wisconsin, enough cheese curds to kill any innocent lactose intolerant, and a road kill tally (of identifiable animals) of over 14 deer, 19 raccoons, 8 skunks, 5 jackrabbits, 6 turtles and 10 armadillos from central Wisconsin to Texas, we arrived in Dallas.

It is slowly sinking in that this will be my home for at least the next four years, and I’m alternating between feeling excitement and pure terror.  Mostly the terror isn’t for the place itself, although that comes in waves, but is more associated with the fact that in a few weeks I’m going to be a practicing physician after months of sitting on the couch.

I’ve heard it a thousand times, but Dallas is hot!  When we got here in the middle of the day, my little peanut of a car was roasting after an hour in the sun.  It’s only May.  My hands are so balloon-like swollen after walking around that I need a Lasix and if I had an unexpected trauma they would have to take a diamond saw to my ring. 

People say we’ll get used to the temperatures.  I have to think this is true, considering I somehow miraculously and unhappily got used to winters every year in Chicago, Vermont, and Cleveland.  Science shows as people acclimatize to hot weather, they begin to overheat less and sweat more efficiently without losing as much salt; this effect is thought to be enhanced by exercise [1,2].  Time to come out of hiding and go on a walk.

Well, I’m going to stay in hiding for just a few moments, because I’m thrilled to be back in the kitchen.  My new kitchen has seven outlets whereas my old kitchen had one.  I’ll be damned however if I turned on the oven unless necessary.  In keeping with my promise to myself to cook healthy food, I have done just that. It is amazing that after weeks of eating out how amazing a simply and freshly prepared meal at home can taste.

I based this cold zucchini basil soup on a zucchini salad that I love to make.  Before you say bleck, give me a chance.  The soup is bright, tangy and delicious.  If you marinate raw zucchini in lemon juice and salt, then not unlike ceviche, the lemon softens the zucchini and blunts the rawness as well as releases a lot of liquid which makes a great base for the soup.  I then added basil, raw garlic, olive oil and a touch of the lovely Mexican cream I love down here to make a lovely cold, pureed and very green soup.  Light, refreshing and easy.  Just like the next few weeks of my life…

Creamy Cold Zucchini Basil Soup

4 medium zucchini
2 large lemons
½ tbsp salt
½ cup packed basil leaves
2 green onions whites and greens
2 cloves garlic
2 tbsp olive oil
½ cup Mexican sour cream (or just take ½ cup sour cream and add 2 tbsp milk to thin)
Water (if needed to thin soup)

Grate zucchini.  Add lemon juice and salt to zucchini in large bowl and refrigerate until cold and zucchini has begun to release juice at least one hour.  Loosely chop garlic, basil leaves and green onion.  Reserve grated zucchini for garnish.  To blender add all ingredients and water if necessary.  Serve cold.

1. Chinevere, TD., et al. “Effect of heat acclimation on sweat minerals.” Medicine & Science in Sports & Exercise, v. 40 issue 5, 2008, p. 886-91.
2. Kampmann, B., et al. “Lowering of resting core temperature during acclimation is influenced by exercise stimulus.” European Journal of Applied Physiology, v. 104 issue 2, 2008, p. 321-7.

The Green Stuff

Oof, I’ve been thinking a lot about the green stuff lately.  A couple of weeks ago, we had our financial aid exit counseling sponsored by multiple corporate groups (including the army) for managing student loans and massive debt.  My medical school class of 140 students borrowed over $16 million for four years of private medical education. 

In 2007, seemingly unbeknownst to me and my friends, although I do remember a bit of buzz from the more politically attuned legion of students, George W passed legislation enacted in 2009 that federal loans cannot be deferred through residency anymore.  Residency does pay a modest but decent salary, but certainly not any glamorous wages, particularly for the amount of hours worked.  The terms of repayment are fair and based on a resident’s income, but interest rates are not that low and debt multiplies fast. 

Looking at the match list from my class, I am convinced that high debt steers medical students towards more lucrative specialties.  The data, however, is not convincing as I would have thought.  A 2005 study published in Academic Medicine showed that indebtedness slightly decreased senior medical students’ likelihood to pursue primary care; the correlation was even greater if the student had more than $150,000 in loans [1].  However, a 2006 study of 2022 senior medical students showed that there was no correlation between debt amount and specialty choice [2].  Even so, it is very hard to explain the primary care shortage without looking at the sky-rocketing cost of medical school. 

If debt only slightly affects career choice, it has also been shown to affect physicians’ lives long after graduating.  A 2009 study in the Annals of Surgery of 550 academic surgeons reported that many surgeons felt that their academic debt affected their academic productivity, career choices and quality of life [3]. 

I certainly am not worried about living on a budget and spending within my means, but growing up is hard!  Responsibilities beyond my professional obligations are accumulating rapidly.  I can barely do laundry.  And I certainly can’t keep my room clean.  Now I have to keep track of my cash and make sure I don’t forget to pay the loan man.  Yeah, I know I sound like a big baby crying about things that every adult confronts.  WAAAH!

Fortunately, spring is here and the attainable green stuff is popping up all over.  No, money still doesn’t grow on trees, but broccoli grows on stalks and you get to eat it.  This broccoli dish that I threw together last week is bright, light and easy and is a great accompaniment to pasta, chicken or really anything else.  Raisins seem like a strange thing in vegetables, but they add the slightest bit of sweetness and mellow out with the salty, acidic accompaniment of the broccoli.  Plus, they were sitting on the counter and I need to get rid of them.  Isn’t that the biggest motivator for eating anything?

The green stuff (broccoli with raisins and pine nuts)

1 bunch of broccoli, rinsed, trimmed into crowns with ~1 inch of stalk
½ tbsp butter
½ tbsp olive oil
1/2 tsp salt
2 tbsp raisins
2 tbsp vermouth, sherry, white wine or water
2 tbsp pine nuts, walnuts, sliced almonds (any nuts really, optional)
Juice of 1/2 lemon

Rinse broccoli and cut into florets.  Over medium high heat in sauté pan, melt butter and oil.  Add florets and raisins, cook until slightly brighter green, about 3 minutes.  Add vermouth, cover another 2 minutes.  Add pinenuts, sauté for another minute, dress with lemon and serve. 

1. Rosenblatt, RA.; Andrilla, CH. “The impact of U.S. medical students' debt on their choice of primary care careers: an analysis of data from the 2002 medical school graduation questionnaire.” Academic Medicine, v. 80 issue 9, 2005, p. 815-9.
2. Kahn, MJ., et al. “Is medical student choice of a primary care residency influenced by debt?.” MedGenMed, v. 8 issue 4, 2006, p. 18.
3. Kibbe, MR., et al. “Effect of educational debt on career and quality of life among academic surgeons.” Annals of Surgery, v. 249 issue 2, 2009, p. 342-8.